Reverse geometry designed scleral lens helps vision restoration in a post-graft patient

Abstract

A 50-year-old man having keratoconus in both eyes was seen for contact lens fitting. Corneal transplant and cataract surgery were performed on the left eye 10 years previously with intraocular lens implantation. He wore spectacles after surgery but the vision was not good. After trial fitting, corneal rigid gas permeable contact lens with keratocnous design was fitted at right eye. As the smaller diameter lens could not give a good fitting for the left eye, a scleral lens with 18.2 mm in diameter was tried. Due to the oblate shape of the graft/host corneal surface, reverse geometry design was finally ordered by steepening the limbal curve of the lens. The corneal clearance of scleral lens was found gradually decreased with time at aftercare visits scheduled after weeks and then months. By adjusting the lens with higher lens sag, better fitting could be achieved. The patient had better vision and good comfort with the contact lens wear. Lens settling with longer wearing time may happen in some patients and the amount vary among individuals. Scleral lenses fitting and ocular health condition should be monitored regularly with time, especially in new wearers. Scleral lens is an option for post-graft patients when other visual aids cannot achieve satisfactory visual performance. Specific scleral lens designs and lens curve adjustment may be needed in patients having irregular cornea such as keratoconus and post-surgical eyes.